作者投稿
专家审稿
编辑办公
邮件订阅
RSS
Differential Diagnosis between Coronavirus Disease 2019 and Interstitial Pneumonia
-
摘要: 2019年12月以来，我国陆续出现新型冠状病毒肺炎(coronavirus disease 2019，COVID-19)病例，主要表现为发热、干咳、呼吸困难、外周血白细胞不高、淋巴细胞降低以及肺内阴影。国家卫生健康委在短期内连续7次修订诊疗方案，足以说明该病诊疗难度之大。部分COVID-19患者影像学表现为双肺弥漫性间质改变，与临床中所见的某些间质性肺炎相似。在当前全球COVID-19疫情形势仍极为严峻的情况下，需与某些急性或急进性间质性肺炎进行鉴别诊断，既要防止漏诊，又要防止因误诊而贻误原发病的治疗。本文将COVID-19与北京协和医院历年收治的多种间质性肺炎进行比较，提出了鉴别诊断思路。Abstract: Coronavirus disease 2019 (COVID-19) emerged in China in late 2019, which was manifested as fever, cough, dyspnea, normal level of white blood cells, decreased blood lymphocytes, and pulmonary opacities on CT scans. National Health Commission of the People's Republic of China has revised the recommendations on COVID-19 seven times, but there are still many challenges in the diagnosis and management of COVID-19. The radiological findings in a proportion of patients revealed diffuse interstitial opacities, mimicking interstitial pneumonia. Thus it is essential to differentiate the COVID-19 from the acute and progressive diffuse interstitial lung diseases in order to avoid misdiagnosis or overdiagnosis. Therefore, our study compared COVID-19 with interstitial pneumonia and tried to explore the differential diagnostic algorithm.利益冲突 无
-
图 1 新冠肺炎患者胸部CT表现
A.病例1，35岁女性，起病第5天，胸部CT显示双肺散在片状磨玻璃影；B.病例1起病第10天，胸部CT显示病变范围增大、密度增高，以胸膜下分布为主的磨玻璃影和实变影；C.病例1起病第14天(治疗后)，胸部CT显示肺内阴影吸收，遗留胸膜下为主的磨玻璃影、索条影和胸膜下线；D.病例2，52岁男性，起病第2天胸部CT显示以胸膜下为主，部分沿支气管血管束分布的广泛磨玻璃影；E.病例2起病第13天(治疗后)，胸部CT显示实变影和索条影；F.病例3，56岁男性，起病第10天胸部CT显示双肺胸膜下为主的磨玻璃影及网格影(铺路石征)；G.病例3起病第14天(治疗后)，胸部CT显示病变吸收，遗留磨玻璃影和索条影；H.病例4，34岁男性，起病第10天胸部CT显示双肺弥漫性磨玻璃影和实变影，病变沿支气管血管束和胸膜下分布；I.病例4起病第14天(治疗后)肺内阴影显著吸收
-
[1] Huang C, Wang Y, Li X, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China[J]. Lancet, 2020, 395:497-506. [2] Wang D, Hu B, Hu C, et al. Clinical Characteristics of 138 Hospitalized Patients With 2019 Novel Coronavirus-Infected Pneumonia in Wuhan, China[J]. JAMA, 2020, 323:1061-1069. [3] Chen N, Zhou M, Dong X, et al. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study[J]. Lancet, 2020, 395:507-513. [4] Li Q, Guan X, Wu P, et al. Early Transmission Dynamics in Wuhan, China, of Novel Coronavirus-Infected Pneumonia[J]. N Engl J Med, 2020, 382:1199-1207. [5] 李妍, 徐胜勇, 杜铁宽, 等. 2019新型冠状病毒肺炎临床特点及筛查流程探讨[J].中华急诊医学杂志, 2020, 29:320-324. [6] Guan WJ, Ni ZY, Hu Y, et al. Clinical Characteristics of Coronavirus Disease 2019 in China[J]. N Engl J Med, 2020, 382:1708-1720. [7] 国家健康卫生委办公厅, 国家中医药管理局办公室.新型冠状病毒肺炎诊疗方案(试行第七版)[S].国卫办医函[2020]184号. [8] 北京协和医院新型冠状病毒感染的肺炎诊治专家组.北京协和医院关于"新型冠状病毒感染的肺炎"诊疗建议方案(V2.0)[J].协和医学杂志, 2020. doi: 10.3969/j.issn.1674-9081.20200022. [9] Xie XZ, Zhong Z, Zhao W, et al. Chest CT for Typical 2019-nCoV Pneumonia: Relationship to Negative RT-PCR Testing[J]. Radiology, 2020, 296:E41-E45. [10] 黄璐, 韩瑞, 于朋鑫, 等.新型冠状病毒肺炎不同临床分型间CT和临床表现的相关性研究[J].中华放射学杂志, 2020, 54:300-304. [11] Chung M, Bernheim A. CT Imaging Features of 2019 Novel Coronavirus (2019-nCoV)[J]. Radiology, 2020, 295:202-207. [12] 中华医学会放射学分会.新型冠状病毒感染的肺炎的放射学诊断:中华医学会放射学分会专家推荐意见第一版[J].中华放射学杂志, 2020, 54:279-285. [13] Tian S, Hu W, Niu L, et al. Pulmonary Pathology of Early-Phase 2019 Novel Coronavirus (COVID-19) Pneumonia in Two Patients With Lung Cancer[J]. J Thorac Oncol, 2020, 15:700-704. [14] Xu Z, Shi L, Wang Y, et al. Pathological findings of COVID-19 associated with acute respiratory distress syn-drome[J]. Lancet Respir Med, 2020, 8:420-422. [15] Luo W, Yu H, Gou J, et al. Clinical pathology of critical patient with novel coronavirus pneumonia (COVID-19)[J]. Preprints, 2020.doi: 10.13140/RG.2.2.22934.29762. [16] Bradley BT, Bryan A. Emerging respiratory infections: The infectious disease pathology of SARS, MERS, pandemic influenza, and Legionella[J]. Semin Diagn Pathol, 2019, 36:152-159. [17] Guarner J. Three Emerging Coronaviruses in Two Decades[J]. Am J Clin Pathol, 2020, 153:420-421. [18] Travis WD, Costabel U, Hansell DM, et al. An official American Thoracic Society/European Respiratory Society statement: Update of the international multidisciplinary classification of the idiopathic interstitial pneumonias[J]. Am J Respir Crit Care Med, 2013, 188:733-748. [19] 施举红, 许文兵, 刘鸿瑞, 等.多发性肌炎/皮肌炎合并肺间质性病变的临床特征[J].中华结核和呼吸杂志, 2008, 31:250-254. [20] 施举红, 许文兵, 刘鸿瑞, 等.隐源性机化性肺炎18例的临床病理特征[J].中华结核和呼吸杂志, 2006, 29:167-170. [21] 施举红, 严晓伟, 许文兵, 等.药物性肺损伤的临床诊断与治疗[J].中华结核和呼吸杂志, 2007, 30:161-166. [22] Azadeh N, Limper AH, Carmona EM, et al. The Role of Infection in Interstitial Lung Diseases: A Review[J]. Chest, 2017, 152:842-852. [23] He H, Wang H, Li X, et al. Successful management of refractory respiratory failure caused by avian influenza H7N9 and secondary organizing pneumonia: a case report and literature review[J]. BMC Infect Dis, 2019, 19:671. [24] Asai N, Yokoi T, Nishiyama N, et al. Secondary organizing pneumonia following viral pneumonia caused by severe influenza B: a case report and literature reviews[J]. BMC Infect Dis, 2017, 17:572. [25] Liu H, Li J, Chen M, et al. Glucocorticoid treatment of suspected organizing pneumonia after H7N9 infection: A case report[J]. Medicine (Baltimore), 2019, 98:e16839. [26] Ishiguro T, Kobayashi Y, Uozumi R, et al. Viral Pneumonia Requiring Differentiation from Acute and Progressive Diffuse Interstitial Lung Diseases[J]. Intern Med, 2019, 58:3509-3519. -
下载:
点击查看大图
图(2)
计量
- 文章访问数: 547
- HTML全文浏览量: 83
- PDF下载量: 50
- 被引次数: 0
